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Using Health IT Beyond the EHR to Support
Changing Care Models
Session NI4, February 11, 2019
MaryAnn Connor, MSN, RN-BC, CPHIMS, Director, Nursing Informatics, Memorial Sloan Kettering Cancer Center
Jean Adams, RN, BS, CNIO, ACIO, Geisinger
Ann Lockhart, MN, RN-BC, Assistant Vice President, Clinical Informatics and Transformation, Ochsner Health System
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MaryAnn Connor, MSN, RN-BC, CPHIMS, Director, Nursing
Informatics, Memorial Sloan Kettering Cancer Center
Jean Adams, RN, BS, CNIO, ACIO, Geisinger
Ann Lockhart, MN, RN-BC, Assistent Vice President, Clinical
Informatics and Transformation, Ochsner Health System
Have no real or apparent conflicts of interest to report.
Conflict of Interest
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• Outline what happens before and after patients are in acute care
including care transitions across the spectrum
• Discuss key indicators for demonstrating the impact of changing
care models and the role of health information and technology
• Share success stories for how an organization positively impacted
patient care and experience
Learning Objectives
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Ann Lockhart, MN, RN-BC, Assistent Vice
President, Clinical Informatics and
Transformation, Ochsner Health System
Virtual Innovative Patient (VIP) Nursing Care
Using Technology
to Enhance Patient Care
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• Telemedicine technology
• Medical Surgical Nurses use technology to
enhance nursing care
• Redesigned care model
• Virtual registered nurse (VN) who is an active
supporting member of the care team
VIP Project
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VIP Model of Care
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Anticipated Benefits
• Improved HCAHPS scores for communication with nurses, pain management,
responsiveness of hospital staff, communication about medications, discharge
information
• Early intervention for patient deterioration
• Improved Patient Safety and Quality Outcomes
• Efficiency with Patient Throughput
• Leaner staffing model
• Improve Nursing Turnover rate
• Greater Employee Satisfaction
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VIP Project Teams
Clinical
• Pursuit of Value Black Belt ( project manager)
• Nursing Informatics – Quality and Safety team
• Nursing Research
• Nursing Unit Teams
• Nursing Leadership
Information Technology
• Nursing Informatics – Information technology ( project manager)
• EMR build team
• Information Technology Technical Team
• Telemedicine Team
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Implementation
• Scope of practice - LPN/RN/nursing assistant
and Virtual Nurse
• Change management sessions- team building,
change in practice
• Technology adoption and use strategy
• Operational standards for practice changes
• Go live readiness assessment
• Legal considerations related to video monitors
• Metrics selected and real time dashboard
created
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Technology
Use of Technology-Patient room monitors:
Hardware Configuration in patient
room includes:
32 inch computer Monitor-clinician
use
Pan, Tilt, Zoom Camera
Speaker & Microphone
Tablet
Monitor on patient wall displays:
Room Number, Fall Risk, Pref Language, Treatment
Team, Schedule, ‘Paint Board’, Code/RRT event log
© 2019 Epic Systems Corporation. Used with permission.
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Technology
Use of Technology-Telemedicine Bunker
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Technology
Use of Technology- Tablet for Patient use
• Each Tablet has a shared video account to allow for 2 way
video between the patient and Virtual Nurse
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Big Wins
• Patient/Family expressing real time/anytime access to lab
results and education
• Providers view x-rays in room with patient and family
• Nurse good catches
• Elevated K+, arranged dialysis
• Allergic reaction to a medication, notified response team
• Proactive care including early discharge planning
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Opportunities
•Technology selection
•Consistent use of technology
•Unit implementation at same time
•Nursing team Communication (report, during shift huddles)
•Handoff report structure and length
•Patient bed placement and assignment of staff nurse
•Geographical, acuity and repeat assignment
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Jean Adams, RN, BS, CNIO, ACIO, Geisinger
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Our Values and Strategy
Foundational elements
Patient and Member Partnership
Value & Affordability
Accountability
Integrated Delivery
Our values
Kindness
Excellence
Learning
Innovation
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Where We Care for People
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The Challenges
Significant efforts have been focused on improving health:
 Patient-centered primary care
 Hospital TOC
 Post-acute network redesign
 Best practice pharmacy management
Primary care
redesign
• Access
• Visit approach
• Quality
• Patient experience
• Staff experience
Care management
expansion
• Primary Care
• Emergency
Department
Specialty
integration
• Hospital transitions
• Heart Failure
• Chronic pulmonary
disease
• Biologics
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The
solution
Care
closer
to home
Urgent Care
i
Home
Telemedicine
Nurse
Triage
Care
managers
Wellness and
Prevention
My Geisinger
Mobile
Care
Urgent Care
Hospice
Mental
Health
Primary
Care
Tertiary/Quanternary
Hospital
Micro Hospital
Community
Hospital
$
Air medical
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Significant opportunity remains
Small portion of patients drive majority of medical costs
Member Population
Total Medical Costs
8–10%
Medicare
patients
55–60%
Medicare
patient costs
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Creating a Care Model in our Communities
- Supporting those with serious & significant health conditions
Longitudinal
Medical Care
• Comprehensive
assessment of
disease burden
• Condition
optimization &
management
• Close coordination
with PCP/SCPs
• Mobile
paramedics
• Case
Management
• Home Health
Geisinger at Home
Integrated Acute Care
Social &BH
• Social
determinants of
health
• Behavioral health
Advanced
Illness
• Plan of care
• Symptom
management
• Palliative care
• Timely transition to
hospice
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Who are we focused on?
How are we identifying
them?
Multiple chronic conditions and
high utilization
Proactive identification from
claims analysis
Palliative care or advancing
illness
Provider or family referral,
claims
High risk hospital or emergency
department utilization
Transitions of care
Which individuals are we focused on?
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In-home team
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Regional Medical Director
1 AP
360–400 pts
1 AP
360–400 pts
1 AP
360–400 pts
1 AP
360–400 pts
4 RNS
3 direct care
1 acute
4 RNS
3 direct care
1 acute
4 RNS
3 direct care
1 acute
4 RNS
3 direct care
1 acute
1 CHA 1 CHA 1 CHA 1 CHA
Social Worker, Dietitian, Pharmacist, Behavioral Health, Palliative Care, Paramedic
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Geisinger at Home Enrollment Trending
4/6
/20
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Total Currently Enrolled
1 3 6 9 14 19 30 53 69 104 139 177 217 246 292 342 401 451 528 585 639 684 713 757 820 863 926 979 104 111 117 122 125 130 133 140
Total Disenrolled
0 0 1 1 3 3 5 5 5 9 14 15 17 18 20 21 23 24 25 25 25 25 25 30 34 37 47 59 74 82 86 91 113 121 139 149
Total Ever Enrolled
1 3 7 10 17 22 35 58 74 113 153 192 234 264 312 363 424 475 553 610 664 709 738 787 854 900 973 103 112 119 125 131 137 142 147 155
0
200
400
600
800
1000
1200
1400
1600
1800
Patient Enrollment Totals
Enrollment As Of Date
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ROS
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Note for Provider after both ROS and PE have been completed:
all positives show in Red
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More than $500 PMPM improvement
PRE POST
PRE POST
38%reduction
in ED visits
26% reduction
in IP admissions
(per1,000)
More satisfied
patients
More coordinated care
Lower utilization
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Restoring Meaning to there is no place like
home
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Using Health IT
to Support
Changing Care Models
MaryAnn Connor, MSN, RN-BC, CPHIMS
Director, Nursing Informatics | Memorial Sloan Kettering Cancer Center
BEYOND THE EHR
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3
0
95
287
287
80
495
78
95
Manhattan
MSK Rockville Centre
Rockville Centre, NY
MSK Commack
Commack, NY
MSK
Hauppaugue
Hauppauge, NY
MSK Westchester
West Harrison, NY
MSK
Monmouth
Middletown, NJ
MSK Basking Ridge
Basking Ridge, NJ
N E W Y O R K
N E W J E R S E Y
CO N N E C T I C U T
MSK Bergen
Bergen, NJ
MSK Nassau
Nassau, NY
Planned location
MSK Locations
31
2000
3
1
31
1880 1900 1920
1940
1960 1980 2020
Hospital
moves to
present
location
Schwartz
Research
Sloan
Kettering
Institute
Rockefeller
Research
Labs
Hauppauge
outpatient
Sleepy Hollow
first regional
outpatient facility
Josie Robertson Surgery Ctr.
Zuckerman Research Ctr.
Basking Ridge outpatient
Nov. 2019
David H. Koch
Center for
Cancer Care
Final large building project
Memorial
Hospital
Rockefeller Outpatient Pavillion
(53rd Street)
Kimmel
Center
Commack
outpatient
Denville
Rockville
outpatient
Westchester
outpatient
BAIC
BIC
Monmouth
outpatient
Bergen
outpatient
April
Nassau
outpatient
First U.S. institution
devoted to oncology
1884
New York
Cancer Hospital
Building a Future
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3
2
By the Numbers
70%
Total Visits at MSK performed
in an Outpatient Setting
» Chemotherapy
» Radiation Oncology
» (OP/AXR) Surgery
36%
2016 2017 PCT
OP Sx 4,184 4,515 64%
AXR 2,338 2,524 36%
JRSC Surgical Visits 6,522 7,039
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3
3
Value-Based Care
Clinical
Quality
& Safety
Unmatched
Patient
Experience
Efficiency
and Cost-
Effectiveness
Innovation,
Collaboration,
and
Continuous
Improvement
!
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3
4
Technologies Impacting MSK Care Models
Transitions
of Care
»MyMSK
› MSK Prepare
› MSK Engage
› My Learning
Key
Indicators
»AHS and High Risk
Referrals
»JRSC Electronic
Care Pathways
»Recovery Tracker
Pathways
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3
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MyMSK
MSK
Prepare
MSK
Engage
The Patient Portal
Available to patients since 2006
New Patient
Health
Information
Systems
My
Learning
Appointment
Scheduled
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
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3
6
MyMSK
A digital resource designed to guide
people from their initial contact with
MSK to their first appointment
Appointment
Scheduled
Health
Information
Systems
My
Learning
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
MSK
Engage
MSK
Prepare
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3
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MyMSK
Our electronic tool that enables the
collection and visualization of patient
generated health data (PGHD). MSK
clinicians can collect data from new and
active patients both remotely and on-site
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
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3
8
MyMSK
A self-reported form
completed by the patient
or designee prior to
receiving care
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
Adult Health
Screening (AHS)
39
3
9
MyMSK
Used to assess
patient risk factors
and initiate appropriate referralsbased on
positive screening factors and establishes
the nurse-patient relationship
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
AHS and
High Risk Referrals
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4
0
MyMSK
Patient Education
Documentation Form (PEDF)
Enhanced Recovery
After Surgery (ERAS) Program
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
Pre-Surgical Preparation
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4
1
MyMSK
Pathway
Order Within
Order Set
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
JRSC Electronic Care Pathways
CPOE
Orders
Pathway –
Specific
Events
Flowsheets
Display
Observations
CIS Status Board
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4
2
MyMSK
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
Patient Education and Discharge
Instructions
43
4
3
MyMSK
New Patient
Outpatient
Visit
Pre-Surgery
JRSC Surgery
Outpatient
Follow-Up
Health
Information
Systems
My
Learning
Appointment
Scheduled
MSK
Prepare
MSK
Engage
Recovery Tracker Pathway
Post-Op RN
calls patient
the next day
Patient
receives
recovery
tracker
messages
Office Practice
RN receives RT
alert or referral
from Post-Op
RN
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2017 JRSC Quality Metrics
36%
2,799/
7,695
AXR
Cases
0.8%
Admission
Rate
3.2%
UCC Visits
within
30 Days
1.9%
Readmission
within 30 Days
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MaryAnn Connor
connorm@mskcc.org
Thank You
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Questions
